Ethics Of Death Are Addressed At Seminar

November 3, 1985|By Nancy E. Roman, Staff Writer

PEMBROKE PINES — Legislation decreeing that life ends when the brain stops functioning has required many new decisions by health-care professionals accustomed to keeping the body functioning as long as possible, according to the director of the Bioethics Institute at St. Francis Hospital in Miami Beach.

The difficulties for health-care workers are compounded because society has not yet accepted brain death as the end of life, despite its legal definition as such in most cases, Dr. James McCartney said.

McCartney addressed current dilemmas of medical ethics at a seminar sponsored by Pembroke Pines General Hospital on Monday.

``If we really believed what the law said, we would think of a brain-dead person as nothing more than a cadaver on a respiratory and circulatory machine,`` McCartney said.

McCartney referred to a recent case of parents refusing to have their 17- year-old daughter removed from life-support systems even though she was diagnosed as being brain dead.

``The papers kept referring to her by name as though she were still a person,`` McCartney said, ``when, if we believe the legislation we passed, she had been dead for weeks.``

McCartney said that although the brain may not be functioning, it is hard for people to accept anyone as being dead when a heart beats and a respirator expands and contracts lungs, pushing warm air from the nose.

``But we must accept `brain dead` as dead if we believe the law,`` McCartney said. ``At the Institute, we are trying to solve dilemmas brought about by technology and changing society.``

He said the change from a society in which one doctor knew all his patients to one in which people move from state to state, frequently changing physicians, has made it more difficult to decide how to care for the terminally ill.

McCartney said one response to that change was passage of the Life Prolonging Procedure Act of Florida in October 1984, which legalized ``living wills,`` documents that allow individuals to make decisions ahead of time regarding their care if they are physically unable to do so later.

Another problem lies in the definition of ethics: ``What we ought to do in light of who we are,`` McCartney said.

He said while the health-care professional`s goal is to preserve life at all costs, the individual`s goal is autonomy, the right to make his or her own decisions.

``This is where the living will comes in,`` McCartney said. ``It lets the individual decide.``

McCartney said a person can request to withdraw, withhold or give any life- support systems in a living will.

``Don`t forget there are people who want to have every treatment possible, and the will allows for them to,`` McCartney said.

McCartney distributed copies of living wills to the 50 who attended the ethics seminar. He said they require only the signature of the subject and two witnesses to be official.

McCartney also emphasized that before the living will, people should consider the need for preventative health care.

``You have an obligation to yourself to eat a balanced diet and get exercise,`` he said.

McCartney said there are differences among religious groups about how to handle the removal of life-support systems. ``But it is basically something the individual has to decide. The `ethics` are unique to each person.``